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HomeMy WebLinkAbout10547 (5) _� �.. :� - -- - CITY OF DIAMOND BAR ��,- I COMMUNITY DE�BLOPMENT DEPARTMENT ' � 21660 B.Copley Dnve Suite 190 f /�� PRESS � (909)860-3195 Fax(909)861-3117 ,/1�.�/ ,�'""' $UILDINGPERMITAPPLICATION �.. ' FIRMLY � JOBSITE , � r� ) � 7 �� APPLICATION- PERMIT f/� P/C o ADDRESS L� .L-- ..-� �/ DATE ���' � �NUMBER "'�� # c� . ISSUE TYPE OCC APN LOT TRACT DATE CONST. GRQUP j p OWNER ���i ��LI f5'1�' o ADDR SS ZONING SETBACKS w FRONT _ RW ❑ � CITY _ ZI�(�" TEL. ? � REAR ❑ o APPLICANT TEL. SIDE/SIDE STREET RW ❑_ z a CONTRACTOR � . SIDE ❑__ � CiTY ES 'ZiP�i'�i TEL. _ PROPOSED USE � , ' ' ' o ARCH/ENG/ c .. L z DESIGPIER NO.DWEL. O. N0. a� A�DRESS UNITS � STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cr� � OWNER-BI:ILDER DECLARATION SFR/ADD/AEM O p 1 HEHEBY AFFIRM UNOER PENALTY OF PEFJURY THAT I MA E%EMPT FROM THE CONTAACTOflS LI� GBffiJO/CBf(OIf W CENSELAWFORTHEFOLLOWINGflEA50N�5EC.1o31.58U51NESSANDPROFE5510N5CODE:ANYCIfYOR (/� U COUHTYWHICHREOUIftESAPERM1T7000N5TRl1CT,ALTEH,IMPflOVE.DEMOL15M,ORREPAIRANY5Tfll1G W PaIIO/DBCR � W TURE.PRIOP TO ITS ISSUANCE.AL50 RE�UIqES 7HE APVLICANT FOR SIICH pERMIT TO FILE A SIGNED W � STATEMENT THAY HE Oq SHE IS LICENSEU PUNSUANT TO THE PqOVI510NS OF lHE CONTflACTOFLS LI� . � CENSE lAW(CHAPTER 9(COMMENCING WI"fH SLCTION 70Do)OF UIVISION 30F TME BUSMESS ANO PHP u' POOVSpfl FE5510NSCADE)ORTHATHEOflSHEISEXEMPiTHEREfROMpNDTHEBA5I5FORTHEALLEGEOEXEMR (� � TION.ANYVIOLATIONOFSECTION7031.SBYANYAPVI.ICPNTFURAPEfiM175Uf7JEGTSTHEAPPLICPNTTO Z R¢-Root � A CIVIL PENALTV OF NOT 1AORE THAN FIV[NUNORED DOLIARS(f500)J: , 0 ;71.ASOWNEHOFTHEPROPERTY,ORMVEMPLOYF.ESWITHWAGESASTHEIRSOLECOMPENSA710N, O Commercial Z WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDFO QR OFFEPED FOR SALE(SEC.7064,BUSI- J � NESS AND PflOFESSIONS CWE:TNE CONTRACTOPS LICEN.E LAW OOES NOT APPLV TD pN OWNER OF � PROPERTY WH06UILOS OR IMPflOYES THEflEON,AND WHO DOF.S SUCH WORN HIMSEIf OR HERSELF OR (= THROU6HHISORHEROWNEMPLOVEES,PFlOVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDEOOq m � OFFEREDFOR3ALE.IF,HOWEVEF,THEBUIL�INOORIMPROVEMENTlS50lDWI7HINONEYEAROFCAMPLE- Z TION,iNE OWNEq�BUILDER WIIL HAVE THE BUR�EN OF PROVING THAT Hf.OR SHE DIU NOT HUIID Ofl IMPROVE FOR THE Pl1flPO5E OF SALE). w ❑I.ASOWNEROFTHEPROPEflTY,AMEXCLl15IVELYCONTRACTINGWITHLICENSE�CONTRACTORS �� � TO CONSTRUCT 7HE PflOJEC7(SEC.7oa9,BUSINE55 AND PROfE5510NS COOE:THE CONTRAC70q5 LI� Valuation _ ADJ.AREA_ W GENSELAWDOESNOTAPPLYTOANOWNEROFAPflOPERTYWHOBUILDSORIMPflOYESTHEREON,ANO � WHOCONTRACTSFOPSUGHPP0.)ECTSWITHACONTRACTOR�9)UCENSEDPURSt1AMTOTHECONTqNC� QUANTITY DESCRIPTION FEE Y TOqSLICENSELAW.). Q ❑1 AM EkFMPT UNDER SEC. ___.____.__B.8 P.C.FOP.THIS REASON U � � __,_.�. .._. .-" "_. '- ¢ u' DATE__ __ __ OWNER___, _ ___ U Z W � LICENSED CONTRACTORS DECLARATION W � I HEFEBY AFFIPM UNDER PENALIY OF PERJURV iHAT I AM LICENSED UNOEFl PHOVISioNS OF CHAVTER � d B(COMMENCIN6WITHSECTION7000)OFDIVISION30FTIIEBIJSINESSANDPROFESSIONSCOOE.ANO Z �X MY UCENSE IS IN NLL FORCEAND EFF�i � �y � � LICENSE CtAS �_'.___ LIC.NO._ __ ��.. (. � V DATE ��coNTRAc7o- � �- W � WORKERS'COMPENSATION pECLARATION ��� � � � IHEREBYAFFIPMUNDERDENALTYOFPERJURYONEOFTHEFo1.�OWINGDECURnTION�r( Z. C/� a O _. AVEAN�WILIMAINTAINACERTIFICA7EOFCONSENTTOSELFdNSUflEFORWORKERS' _ CAMPENSATION.ASPqOVI0E0BY5ECTION37000FTMELABORCODE.FORTHEPERFORMANCE U d� OFIHEWORKFORWHICHTNISPERMRISISSUEO. � O — � _I HAVE AN�WILI MAIN7AIN WOAKEHS'COMPENSATION INSURANCE,AS REOUIRED BV S[CTION ;( �r,� d 3]Oa OFTHE IAeOR COOE,FOfl THE PERFORMANf,E OF THE WORK FOR WHICHTHIS PERMIT IS �. � �SSUEO.MV WOPKE S'COM ENSATION INSURANCE CARRIEfi V IGY NIJMBER ARE' CONSTRUCTION _ __ _ _ _ j CAFRIER r� �+��:. _.__� PLAN REVIEW `-- --- , _,_ _ [����—�_ � `•' � POLICYNUMOER._.i� —.:�.7�._ _.-{} ELECTRIC __ -�'~~ � L3 :� (IHSSECiIONNEEDNDTBEWM�LE�EDOFT�iEPEPlMISFORPtiEfNMRF.DDOIL`^RSR70olIX7LE PLUMBMG __ � __ w 1 C[RTIFY THAT IN THE PERFORMANCE OF THE WOflK FOR WHICH THI3 PERMIT IS ISSUED,1 MECHANICAL � Z "" " �J SMALL NO7 EMPLDV ANY PEflSON IN ANY MANNER SOAS TO BEGOML SUBJEGT TO THE � WORKEftS'COMPENSATIONlAW50FCALIFoqNIA,ANDAGREF.TMATIFISHOULDDECOME fNSPECTIONFEE ,_,. __, ? SUBJECTTOTHEWORNERS'GOM�F.N5ATIONPROVISIOfJ50 ECTION3 OOFTHELABOfi _ +�g�BY d',+, It �19M'"7E _ p COOE, SHAL�WITHCOAIPLYWIiH SEPflOV151 ) ISSUANCE . r e � R a aaa� . .r � �ry SMIP p DATE: � .RPPLICANt�� __ % ' - __. ----' --- ry'— — �✓ W � � ENEFGY P(C J WAR 0:FAILUR O SECURE WOFKEflS'COMPENSATI�N Cq A6E S 11NlAWFUL,ANO SHALI BE �--' -' - -- J � SU CTANEMPLOYER70CRIMINALPENALTIESANUCIVILFINES o NEHUNDREOTHaUSAND ENERGYPERMIT ', �OLUF15(5700.000),IN ADDITION TOTHE COSTOF COMPENSATION,OAMAGE5AS PROVIDED FOfl IN -'- -' -' ' � SECTION 3708 OFTHE LABOR CO�E,INTEREST,AN�ATTORNEY'S FEES. RETENTION FEE: _, _ � CONSTRUCTION LENDING AGENCY __. .__ PRE•ALT FEE: � IHEREBVAFFIRMUNOERPENALNOFPERJURYTHATTHEREISACANSTRUCTIONLENDINGAGENCY _ � FOR THE PEflFORMANCE OF THE WORK PoR WHICH iHIS PERMIT IS ISSVED(SEC.3oB7,qV.G} '-��� �Z - '_'._ � LENDER'S NAME____,__ __- _-._. -- --- __ _ _ _ F- LENDER'SADDRE93_._..____ _. -.— -.-_ - JJJ w1 CERTIF'/THAT I HAVE flEAD THIS APPLICATION AND STATE THAT THEABOVE INFOFMATION IS CORRECT TOTAL FE ES � y�� � IAGflEETOCOMPLYWITHALLCITYANDCOUN7YOR�INANCE5AND5TATEL4W5RFLATINGTOBUILDING CONSTRUCTION.ANO HEREBY AUTHOf1�ZE R[PPE6EN7ATIVES OF TNIS CIXINTY TO FNTER UPON THE Z ABOVGMENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS.__ _—_ __ � �"�-�- v �s���__ -- - � J X _ "' - m P I EE N ( T) � //'�� �� (� Y_� `.� � � GNATl1RE O MITfEE � "" A7E �?/�� � � 7 / Z RECPT.NU. ___PAID BY VALIDATI ~ WHITE—Department Co ,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,6REEN—Applicent's Copy . _. -5 �_._' . � ' ..,.... ._ � I._ I � I � ...'_._ ' � -� 7 � .-.- ... I . � . . � ` 1 I � � �...� I I;. i � i i _ e ,.,.- �. .� I � i � i . I . I .. � ,I I �.... i �.� - � � j � I � k �r t S � i � f � - I"' - I f `'.,,�, ; _ � ' � I . ,.., , ,. , . � . I � l� I % �� � Y I � r I _ �- �:� i � � , .� �. � �� � � � i m , � ;;�,:� � � ' ,' ' ' � i i . �, ,-; I v, �r,� , Y , ��^i � , ► ��� yr I -r I , � l � �� '� , I 'I �.I . �: I �,,� 7 j i �f . � �� " �— � ' �;� u I � � � � °' '� '^�1. � I � i �` i I - � .{i-- ���� ���_�� 1 , � i� , �' � �. �' �� �', � �� ,;. , - I J � � I I �� ,� � I - 1 I. i � I �; 4 , � �, , y �.� � � �.� �.� ' � � ( (' �^I z I f � ' �,I'.J I I I .� � � , � I.�, ,��� �� .,.. I . 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